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Initial Characteristics and Clinical Severity of Hemophagocytic Lymphohistiocytosis in Pediatric Patients Admitted in the Emergency Department
- Source :
- Pediatric Emergency Care.
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- OBJECTIVES The diagnosis and management of children with hemophagocytic lymphohistiocytosis (HLH) admitted in the emergency department (ED) are challenging. The present study aimed at describing the initial characteristics of pediatric patients with HLH upon admission in the ED. Moreover, the clinical severity of the condition was assessed. METHODS We performed a retrospective study of patients who visited the pediatric ED and were newly diagnosed with HLH during hospitalization between February 2012 and January 2017. The patients were classified in the clinically unstable group if at least 1 of the following conditions was observed upon admission in the ED: hypoxia requiring oxygen supplementation, hypotension requiring inotropic support, coagulopathy with prothrombin time (international normalized ratio, ≥1.5), and seizures or altered consciousness. RESULTS We enrolled 31 pediatric patients with HLH, with a median age of 6.53 years (interquartile range, 1.35-13.24 years). Abdominal discomfort along with fever (74.2%) was the most common presenting symptom in patients admitted in the ED. Based on the HLH-2004 diagnostic criteria, fever (96.8%), hyperferritinemia (96.8%), splenomegaly (74.2%), hypertriglyceridemia and/or hypofibrinogenemia (67.7%), and bicytopenia (41.9%) were observed in the patients. However, only 8 patients (25.8%) met the criteria. Nineteen patients (61.3%) were included in the clinically unstable group. This group had lower albumin (2.3 vs 3.3 g/dL, P = 0.002) and fibrinogen levels and higher ferritin level and neutrophil count than the clinically stable group. Meanwhile, the number of clinical findings that met the diagnostic criteria was not different between the 2 groups. Lower albumin level was a significant risk factor in the clinically unstable group (odds ratio, 0.040; P = 0.004). CONCLUSIONS Pediatric patients with HLH often have clinically unstable conditions upon admission in the ED. However, only few patients meet the HLH-2004 diagnostic criteria. Lower albumin level may be useful in assessing clinically unstable patients and preparing for possible deterioration.
- Subjects :
- medicine.medical_specialty
Adolescent
Lymphohistiocytosis, Hemophagocytic
03 medical and health sciences
0302 clinical medicine
Risk Factors
Interquartile range
Internal medicine
medicine
Coagulopathy
Humans
Child
Retrospective Studies
Prothrombin time
Hemophagocytic lymphohistiocytosis
medicine.diagnostic_test
business.industry
Infant
Retrospective cohort study
General Medicine
Emergency department
Odds ratio
medicine.disease
Hospitalization
Child, Preschool
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Emergency Medicine
Absolute neutrophil count
Emergency Service, Hospital
business
030215 immunology
Subjects
Details
- ISSN :
- 07495161
- Database :
- OpenAIRE
- Journal :
- Pediatric Emergency Care
- Accession number :
- edsair.doi.dedup.....d37d2e5d0341759f906d885851b231a7